Individual
SHOBHA NOOKALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
900 MAIN ST, SUITE 400, PEORIA, IL 61602-1005
(309) 672-3100
Mailing address
5100 RELIABLE PKWY, CHICAGO, IL 60686-0001
(309) 672-4809
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
088318
HEALTH ALLIANCE
IL
01
—
472292
HEALTHLINK
IL
01
—
7215059
BCBS PPO
IL
Enumeration date
07/31/2006
Last updated
07/08/2007
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